Inspection on 08/09/06 for Latimer Lodge

This inspection was carried out on 8th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Latimer Lodge 14/05/10

Latimer Lodge 29/03/10

Latimer Lodge 25/08/09

Latimer Lodge 16/09/08

Latimer Lodge 01/12/05

Latimer Lodge 31/08/05

Latimer Lodge 03/03/05

Latimer Lodge 02/11/04

Latimer Lodge 29/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Latimer Lodge 38 Preston Road Yeovil Somerset BA21 3AQ Lead Inspector Justine Button Key Unannounced Inspection 8th September 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Latimer Lodge DS0000016088.V302474.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Latimer Lodge DS0000016088.V302474.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Latimer Lodge Address 38 Preston Road Yeovil Somerset BA21 3AQ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01935 474520 01935 432380 Mr Christopher Michael Bruce Wharton Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Latimer Lodge DS0000016088.V302474.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Miss Rosemary Chew will undertake the Registered Managers Award, commencing in 2003. 1st December 2005 Date of last inspection Brief Description of the Service: Latimer Lodge Residential Home is part of a continuing care complex that includes Tyndale Nursing Home, which provides nursing care and Coverdale Court, which is a sheltered housing complex. All businesses are run entirely independently but come together to share resources, interests and activities. Mrs. Pauline Purnell is the general manager for both Latimer Lodge and Tyndale care homes. Latimer Lodge Residential Home is a fourteen-bed care home providing personal care for older people. It is situated close to the centre of Yeovil. It stands in its own gardens, in close proximity to Tyndale Nursing Home and Coverdale Court. There is good access for frail people and wheelchair users, including pleasant garden areas. Car parking is available. Communal rooms and some bedrooms are located on the ground floor with further bedrooms are on the first floor, some of which are very spacious. One bedroom is for a shared room whilst a married couple are resident at the home. A passenger lift is available for service users. Latimer Lodge DS0000016088.V302474.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over the course of one day in August 2006. The inspector examined selected residents and staff files and looked at other documents relating to the running of the home including policies and procedures. The inspector spoke to the majority of residents, some staff and undertook a tour of the premises. The current fee levels are £430 to £525. Nine people were living at the home on the day of the inspection. The inspector was able to speak to six of these people. What the service does well: The home provides information to prospective residents and their relatives/representatives so that they can make an informed decision about moving into the home. All prospective residents and their families/representatives are given the opportunity to visit the home, spend time there and meet the staff and the manager before they moving. Admission procedures are thorough to ensure that prospective residents social, health and care needs can be met at the home. The aims and objectives of the home reinforce the importance of treating residents with respect and dignity. Residents have right of access to healthcare and medical services. The care at the end stage of life are good. Residents are supported and encouraged to retain control of there own lives as much as possible. Residents to maintain contact with their family and friends and visitors are made welcome in the home. Latimer Lodge DS0000016088.V302474.R01.S.doc Version 5.2 Page 6 Residents were satisfied with the meals served in the home. Residents were confident that any complaints or concerns would be taken seriously. The policies and procedures regarding the protection of residents are clear and protect residents. What has improved since the last inspection? What they could do better: On the day of the inspection the washing machine was broken. The management had organised an outside contractor to undertake the laundry. It was ascertained however that there were continued issues with the current washing machine. Due to this the management should consider replacing the machine in order that people living at the home have a continuous supply of clean clothes and bedding. Although the home has a shower, this is not accessible to all people due to a sharp slope at its entrance. For people who cannot access the bath (which does Latimer Lodge DS0000016088.V302474.R01.S.doc Version 5.2 Page 7 have a hoist) this means a trip to the nursing part of the complex. The management need to ensure that remedial action is taken to resolve this issue. The home does not currently have a hoist (used to support people in moving and handling.) This may be required in the event of people becoming frailer or falling. Consideration should be given to purchasing this equipment. Staff do not currently receive training in the recognition and prevention of abuse. This is required. It is recommended that the management consider the implementation of a quality assurance system. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Latimer Lodge DS0000016088.V302474.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Latimer Lodge DS0000016088.V302474.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 standard six is not applicable to this service. The quality outcome for this group is good. Admissions to the home only take place if the service is confident that they are able to meet the assessed needs of the prospective resident. Each resident is provided with information about the home and a statement of terms and conditions before making a decision on residency. EVIDENCE: The home produces a Statement of Purpose and a service users guide that gives information about the way the home is run to prospective residents and their family. The contract to occupy the care home accommodation is given to all prospective residents and their relatives/representatives. . The manager or a senior member of staff meets with prospective residents and their relatives/representatives and a pre admission assessment is undertaken Latimer Lodge DS0000016088.V302474.R01.S.doc Version 5.2 Page 10 to ensure that the home can meet their needs before they move into the home. The home also takes into account information provided by prospective residents GPs, district nurse and social services if funded via care management arrangements. Prospective residents are encouraged to visit the home and spend time there before making a decision on residency. There are extra charges for newspapers, hairdressing, chiropody, clothing and some trips and activities. These are charged at cost. Latimer Lodge DS0000016088.V302474.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 The quality of this group is good. The aims and objectives of the home reinforce the importance of treating residents with respect and dignity. Residents have right of access to healthcare and medical services. The care plans are in place and are reviewed regularly. Care at the end stage of life is good. Medication was on the whole well managed. EVIDENCE: The home has adopted a person centred care approach. Daily records record care interventions, changes in health and significant events. Latimer Lodge DS0000016088.V302474.R01.S.doc Version 5.2 Page 12 The residents files looked at were generally well kept and had a care plan and relevant risk assessments that were completed and up-to-date. There was evidence that staff work closely with health and medical professionals to ensure that resident’s health care needs are met. Pressure relieving aids were provided as necessary. Staff were observed to treat residents with respect and the homes policies procedures and training make it clear that residents rights to privacy and dignity are paramount. People spoken to during the inspection stated that they were well supported. Comments included “I was very lucky to find such a lovely place” and “I hold the staff in the highest regard. They know if you are not feeling well and will do anything to help you.” For one service users who was at the end stage of life received excellent care on the day of the inspection. Staff were committed to support this individual to a peaceful death although they were aware of their limitations and had sought the advise of the GP, community nurse and hospice nurse. The individual was being cared and supported in accordance with his wishes. These wishes were documented in the plan of care. Staff should be commended for their approach in this area. The management, dispensing and storage of medication was viewed and were generally well managed. The Medication Administration record (MAR) were viewed these were completed in full. For one service user however the GP had written the MAR following a change. The previous prescription had not been clearly discontinued. This may have lead to the inappropriate drugs being given. The staff need to ensure that the MAR charts are clear and any medication no longer required is clearly marked. There was a clear audit trail of drugs entering and leaving the home. Some controlled drugs were in stock and these were documented and stored in line with good practise. For one service user some medication had not been required for some time. Staff need to ask the GP to review this medication and discontinue if required. Risk assessments were in place for two people who self medicate. Latimer Lodge DS0000016088.V302474.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. The quality of this outcome group is good. Residents are supported and encouraged to retain control of there own lives as much as possible. The opportunity for social and recreational activities has increased with the purchase of a mini bus. Residents to maintain contact with their family and friends and visitors are made welcome in the home. Residents were generally satisfied with the meals served in the home. EVIDENCE: The routines of the home are as flexible as possible to meet individual residents choices and preferences. Residents were able to choose to remain in their room or to meet with others in communal areas. The majority of residents’ files checked contained and activities plan with varying detail. Latimer Lodge DS0000016088.V302474.R01.S.doc Version 5.2 Page 14 Since the purchase of the mini bus people living at the home spoke of the trips they had undertaken including trips shopping (one lady showed the clothes she had been able to go out and purchase) and to local areas of interest. One person living at the home stated that this had given her the first opportunity in a number of years to go out. Two people living at the home went for a walk during the inspection. Staff support was available if this was required. Residents spoken to confirmed that they were able to get up and go to bed at times of their own choosing. Residents are able to continue with their personal religious observance if they so wish and this was seen to have been noted on their individual file. The home actively encourages contact with residents’ family, friends and representatives and they are encouraged to take refreshments while visiting. Visiting can take place in communal areas or in residents’ private rooms. The Inspector was invited to stay for lunch. The meal was well presented and was of an excellent standard. Although a choice is not routinely served, people living at the home stated that they would feel able to ask if they did not like what was on the menu. This was seen on the day of the visit with three people having different meal to the fish, which was being served. One person living at the home stated that she sometimes help the cook to prepare the vegetables and the fruit for puddings. The kitchen was clean and tidy on the day of the inspection. The cook was present who was observed preparing the meal. All ingredients were fresh. Home made puddings and cakes are also available. People spoken to during the inspection stated that the food was of a good standard. Comments included “food is excellent” A lighter cooked meal is available in the evening although the people current people living at the home appear to be choosing soup and sandwiches. Latimer Lodge DS0000016088.V302474.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 The quality of this outcome group is adequate. Residents were confident that any complaints or concerns would be taken seriously. The policies and procedures regarding the protection of residents are clear and protect residents. Staff have not had sufficient training in abuse awareness. EVIDENCE: The home had a complaints procedure on display in the entrance hall. All residents spoken to were clear about whom to talk to if they had a complaint or concern. No complaints have been received since the last inspection. The home had an appropriate adult protection policy and procedure that gave clear guidelines to staff on how to recognise and report abuse of vulnerable adults. No staff have received training in this area. This is required to ensure that all staff are provided with information regarding the recognition of and action to be taken should they suspect abuse. Only one staff member has been employed since the last inspection. Appropriate checks including Criminal Record Check and POVA had been completed. Latimer Lodge DS0000016088.V302474.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22, 23,24,25,26 The quality of this outcome group is poor. The home is clean tidy and well maintained. The shower is not accessible to all people living at the home. There is not the necessary equipment should anybody should have a fall. EVIDENCE: The home was clean, tidy and free from odours. All residents’ private rooms were individualised. The residents spoken to were satisfied with the way housekeeping staff kept their rooms clean and tidy. The communal space is light, airy and accessible to all people who live at the home. Décor and furnishings are homely. Latimer Lodge DS0000016088.V302474.R01.S.doc Version 5.2 Page 17 Residents have access to a secure outdoor garden area with seating provided. The service has one bathroom, which contains a bath with a hoist. There is a second bathroom with a shower. The shower has a sloped entrance, which makes it inaccessible to wheelchair users. For one individual at the home this means that they have to go across the driveway to Tyndale to bathe. This arrangement is not satisfactory. Action needs to be taken in order to ensure that there are accessible bathing facilities for all people living at the home. On the day of the inspection one person was nursed in bed. Appropriate equipment including pressure mattress, adjustable bed and slide sheet had been provide by the community nursing team. All the people living at the home currently are mobile. There is however no hoist which is used to support people in moving and handling. This may be needed is anybody became frailer or fell. Consideration should be given to purchasing a hoist for use in these circumstances. On the day of the inspection the washing machine was broken. Testimony from staff and people living at the home confirmed that this had been broken for a period of time and that the machine appeared to break at frequent intervals. A outside contractor had been sourced to complete the laundry in the interim. This arrangement did mean that the laundry was not being completed as frequently as when completed “in house”. Some staff had been taking laundry home in order to ensure that there was not an excessive backlog. This issue was discussed with the manager who stated that there was a maintenance contract in place for the repair of the machine. A part was now available and she was awaiting an engineer to be available to fit this. The management need to consider • Replacing the current machine. • The viability of the current maintenance contract. • Informing the CSCI via regulation 37 forms when the washing machine is unavailable. Latimer Lodge DS0000016088.V302474.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28,29,30 The outcome for this area is good. There are sufficient numbers of staff on duty. Staff are trained, qualified and competent to fulfil their roles. EVIDENCE: There is a committed and dedicated staff team with low staff turn over. The majority of staff have been employed at the home for a number of years. The use of agency staff is low. There are currently two staff available for all waking hours. In addition the manager works on a full time basis. There is a cook and cleaning staff also available. There is one night staff available. There is in addition an on call system to increase this number if required. Due to the needs of one person at the time of the inspection the hospice had supplied an additional member of night staff. The staff training records were viewed. These showed that staff had received all mandatory training including moving & handling, fire prevention and action to be taken in the event of a fire and medication training. As previously stated Latimer Lodge DS0000016088.V302474.R01.S.doc Version 5.2 Page 19 staff should be trained in the recognition and prevention of abuse. This should include details of local and national policies & procedures. Seven staff have a first aid qualification. The management need to ensure that there is a qualified first aider on duty at all times. Four staff currently have an NVQ with an additional two staff currently undertaking this qualification. New staff now receive a formal documented induction which covers all necessary elements. Latimer Lodge DS0000016088.V302474.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 37, 38. The outcome for this group is good. The home is well managed. Records are appropriately stored and systems are in place to protect the best interests of service users. Maintenance is well managed EVIDENCE: The managerial arrangement of a general manager for both Tyndale nursing Home and Latimer Lodge works well, supported by deputy management at each home. The deputy manager for Latimer was present throughout the inspection. Resident monies held by the home are managed robustly in order to protect residents from financial abuse. Latimer Lodge DS0000016088.V302474.R01.S.doc Version 5.2 Page 21 Health and safety issues are managed competently. Maintenance of the homes equipment and servicing was well managed. Accident analysis to review risks and identify hazards is undertaken. This is good practice. The deputy manager works at the home on a full time basis. Due to the small size of the service she regularly meets with people living at the home. There is however no formal quality assurance system in place. This was discussed with the deputy manager who agreed to research and implement a system in view of forthcoming changes to the CSCI inspection process. Latimer Lodge DS0000016088.V302474.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 4 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 2 3 1 2 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 X 3 3 Latimer Lodge DS0000016088.V302474.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP18 Regulation 13 (1) (6) Requirement It is required that all staff receives training in the recognition and prevention of abuse. This should include the action to be taken if staff suspect any abuse. It is required that there are bathing facilities available, which are accessible and meet the needs of all the people who live at the home. Timescale for action 20/12/06 2 OP21 23 (2) (J) 23(2) (a) 15/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP19 Good Practice Recommendations It is recommended that the provision of laundry facilities be reviewed. Consideration should be given to purchasing a new washing machine. Consideration should be given to reviewing the current maintenance contract for this machine. Regulation 37 forms should be submitted for each time the DS0000016088.V302474.R01.S.doc Version 5.2 Page 24 Latimer Lodge 2 3 OP22 OP33 washing machine is out of order. It is recommended that the management consider the purchase of a hoist used in moving and handling. It is recommended that a formal quality assurance system is implemented. Latimer Lodge DS0000016088.V302474.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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